Healthcare Provider Details

I. General information

NPI: 1467380717
Provider Name (Legal Business Name): DAKOTA PAUL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 PRESIDENT ST
BALTIMORE MD
21202-4472
US

IV. Provider business mailing address

5519 ASHBOURNE RD
HALETHORPE MD
21227-2813
US

V. Phone/Fax

Practice location:
  • Phone: 443-603-1704
  • Fax:
Mailing address:
  • Phone: 443-613-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: